Ensuring a Viable Service

Authors

Today, the possibilities offered by the
digital workplace, such as remote reporting and off-hour coverage mean that
virtual radiologists can offer imaging services in new and exciting ways. The
challenge, however, is to provide trust over distance - across departmental or
even national boundaries. In this article, we discuss three major issues in building
trust in remote reporting: organisational change issues, continuous feedback
and legal implications.

Thus
far, remote reporting has been technically restricted by point-to-point
connections and manual sending of patient information between participating
organisations. However, regional solutions for RIS and PACS covering the whole community
have addressed this lack, providing healthcare record summaries or index
databases that are the glue enabling the viewing of images from other
organisations, as well as electronic marketplaces, where consultation services
can be delivered in a flexible way.

Financial and Technical Aspects

Financial
and technical considerations typically dominate the planning of a remote
reporting service. Common questions that are discussed carefully on the side of
the service provider include:

• How
many units of clinical service will need to be sold to cover costs?

• How
many units of clinical service will need to be sold to make a profit?

The
challenge, however, is to provide trust and learning over distance across
departmental or even national boundaries. It is also crucial to understand how
the community will be affected by the proposed service to ensure viability
after the pilot phase and integration as a seamless part of the radiological
operation of a hospital.

In
the following section, three different aspects important in building trust in
remote reporting are discussed: organisational change issues, continuous feedback
and legal implications.

Organisational Change Issues

When
the organisation is prepared for integrating remote reporting as part of the
radiological operation of a hospital, trust in the service itself can be built.
In order to do so, the following factors in the current organisational
environment should be considered:

• What
groups will support the development of a remote reporting service? Why?

• What
groups will block the development of the service? Why?

• How
will you gain support or buy-in for the development of the service in your
organisation?

• What
problems can you anticipate that will affect the success of the remote
reporting service?

The
remote reporting service provider should be closely involved in the
organisational change management of the customer. The customer should get
familiar with the ‘face’ of the service provider. The backgrounds of the
project leader and the core project team and their ability to execute the
business case strategy should be clearly described. At the very least, the
following questions should be answered:

• What
are the roles and responsibilities of the project leader and the project team?

• Who
are the key leaders, what is their experience with similar projects?

• Does
the project team have training or learning needs to support the success of the
proposed project?

• Describe
the function of outside supporting professional services, if any.

• What
are the reporting relationships between key project team members?

Continuous Feedback

When
buying a remote reporting service the customer wants proof of quality, known
and accepted processes and protocols, transparency, possibilities for peer
review and double-blind readings from time to time. On the other hand, the
service

provider
expects access to the relevant data,feedback
on discrepancies and learning fromother
specialists.

A
prerequisite for a self-sustainable remote radiology business case includes
feedback from both radiologists and clinicians in building and main- Thus far,
remote reporting has been technically taining trust in a remote reporting
situation where the service provider is not in the same location and ensuring
transparency in performance and quality indicators. Users of the remote reporting
service should be able to give digital feedback easily and in a user-friendly
way.

At
the same time learning is enabled by systematic automation of feedback on
different levels between participants in the healthcare process. Constructive
feedback creates a safe environment for individual self-improvement. Feedback
software should be easy to use and preferably desktop integrated with the local
RIS/PACS (see fig. 1).

Legal Implications

In
building a remote reporting business case, you should consider the main issues
that may arise from the need to manage personal information in a manner that takes
into consideration both individual sensitivities and the need to provide
healthcare practitioners (and, potentially, patients, administrators and
others) with access to health records. In particular, you need to demonstrate
that you have understood the trust and security implications arising from the
legal and clinical environment in which the remote reporting service is to
operate.

The
following issues should be discussed and agreed on between the service provider
and the customer:

• How
will patient information be stored, transmitted and used so that it is kept
confidential and only shared with those individuals who have a legitimate need
to see it? Will encryption and electronic signatures be needed? How will
patient consent be recorded and, if necessary, used to govern access to
information?

• How
will all actions performed be associated with the individual who performed
them? What manual and automated facilities will be required to maintain and
subsequently process any audit trail/security log etc.?

• What
processes will be used to address disaster recovery and business continuity?

• Who
will provide the service and who, ultimately, will be responsible for the care
of the patient – will clinical responsibility be shared, in fact, between
several clinicians?

• How
much will the patient be told about how their information is used and how will their
informed, voluntary consent be obtained? Who, under what circumstances, may act
on behalf of the patient to grant or withhold consent?

• What
legislation governs the capture, storage, dissemination and destruction of
information? Are there different legal considerations in different relevant
countries? What are the legal implications if the information management
process fails to achieve the required or expected Quality of Service as might
be described in terms of confidentiality, integrity (e.g. completeness and correctness),
and availability (e.g. timeliness) of information?

• Will
the service be offered locally, nationally or internationally? If so will the
radiologists involved need to be qualified and insured to practice in another
country? Will it be necessary for them to revalidate their qualifications or
take new ones?

• If
the service is to be provided online, how will contracts be created and entered
into and how will payments be collected?

Conclusion

Building
trust in remote reporting is a complex and challenging task that should be
carefully considered from several points of view in order to assure a
self-sustainable remote reporting service.�

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